Monday, July 29, 2013

Quote of The Day






Remember Mister Rogers? And the sweaters? :-)

Here is a beautiful quote from Mister Rogers about children and how we must redefine our mental concepts of a "whole" or "normal" child, and accept children based on who they are and not based on our own expectations.



"No child is “perfectly” whole in mind, body, spirit, ability…nor can any child meet all of a parent’s hopes and expectations. Yet there is a wholeness of each and every child, a wholeness that is unique and brings with it a unique set of possibilities and limitations, a unique set of opportunities for fulfillment."


-Fred Rogers, Mister Rogers’ Neighborhood
 

Tuesday, July 23, 2013

Introducing.....ABA Interviews!




A regular reader of my blog who asked to remain anonymous (you know who you are!) had a suggestion to add interviews as a regular blog feature. Her suggestion was that these interviews could be a way for professionals in the field of ABA to share their stories, share their successes and failures, and encourage other people in the field. And you know what?? I agree! :-)



I am happy to announce a NEW  regular feature of my blog where I will interview someone who works in the field of ABA. All of our stories and experiences are so different and so unique, and all of us have something inside of us that can help others. For parents, maybe you have always had questions you would like to ask your ABA therapist, but didn't feel it was appropriate. Now you can take a peek into what its like being an ABA therapist, without the social disapproval!

 These interviews will include people from all over the world, working in a variety of settings, from novices to the more experienced. I do have several interviews lined up already, but if you are working in the field and want to share your story too, feel free to contact me directly (click on "Contact Me" on the right side of the page). I would love to hear from you. Share your story with people, its cathartic!

I hope you are as excited about this new feature as I am, and without further delay I want to introduce my very first interviewee, and a new friend of mine:


Interview

  •          If you would like to, state your name. Anson
  •       State your job title. Transitioning at the moment (in between positions)
  •        Where do you work (location)? Missouri
  •       Do you work independently or for a company/agency? An agency
  •        How long have you been working in the field? About 14 years
  •       When did you obtain your BCBA?  May 2013
  •        Why was pursuing a BCBA important to you? It tells me that I am “good enough” and the BCBA program I was in taught me many concepts and applications that made many behaviors easier to understand.
  •       What do you think is the most important part of a BCBA’s job? Finding the most natural, ethical/legal and logical ways to help improve a client's life
  •     How confident are you in your capabilities as a Behavior Analyst (please rate from 0-100%)?  Not sure yet... I am just starting!
  •       How much of your own money do you usually spend each month on therapy supplies (reinforcers, materials, binders, etc)? I set a limit to $25 or so but I do go over at times.
  •        Do you feel more confident with Skill Acquisition or Behavior Management? Skill acquisition.
  •       Describe some of the problem behaviors you deal with. Food sensitivity, Self-Injurious Behaviors, (SIB), tantrumming.
  •        What ages do you work with? Mostly school-aged children (5-12).
  •       What populations do you work with? (Autism, ADHD, Downs Syndrome, etc) I primarily work with individuals with Autism but I have worked with people with other developmental disorders.
  •        Explain how you got started in ABA. I was a Psych major in college and the classes didn't quite make sense to me until I took a class on Behaviorism. The second part of the class was pretty much Behavior Modification and it really made sense to me. I started taking the next class and doing some fieldwork. After I graduated, a former trainer referred me to an agency.
  •       Before you started working in this field, what did you know about ABA? NOTHING! Part of psychology... if any...
  •        Describe a typical work day. (How long is your day, how many clients do you see, how much driving is involved, etc) Transitioning at the moment, but definitely driving, paperwork, talking to parents, and having fun with kids.
  •       How much do you make per hour? N/A (transitioning)
  •     How many times a week do you feel stressed, overwhelmed, or discouraged at your job? I used to get very stressed but now I will say 1-2 times a week, maybe? I do get discouraged at times when some behaviors continue to occur despite significant amount of time and effort on intervention. Family's concerns and expectations always play a part as well.
  •       How do you deal with the stresses of the job? Talking to my supervisors, reading, video games (DRO, anyone?).
  •        Do you prefer working: in home, in the school, or in the community? Why? It's always a great way to start at a clinic setting at the beginning, but I'll say home and community... where we really have to generalize everything... a little NET and safety don't hurt either.
  •       Do you receive support and active involvement from the families of the clients you serve? Do you wish you received more? Most of the time I  do get great support from the families. After all, we all work towards the same goal: improving the client's life. For some families, I do a little Shaping: I suggest them to focus on only one or two behaviors to start with, and eventually I will get them to be on the same page.
  •  What have been your best and worst experiences with a family/parent? The best experience? The family and I worked as a team, that kind of dedication and partnership really helped the client. The worst experiences? The family that was not involved... and the family got too involved and included me as part of the family. It was an honor and privilege but it was pushing the ethical boundaries at times.
  •       What are the most important skills for a new ABA therapist to learn? Motivating Operations... work that EO!
  •        Name 3 things you wish you could change about your job. N/A (transitioning)
  •       What do you enjoy the most about supervising ABA therapists? I enjoy listening to their ideas and helping them understand the functions of behavior.
  •        Anything you want to add (You can add anything you want to share with people)? Shameless self-promotion here... You can find out more about me and what I have to say at www.behaviorjedi.wordpress.com, and I have a Students of Applied Behavior Analysis Facebook page at: https://www.facebook.com/groups/139460776226228/.

Sunday, July 14, 2013

VB-MAPP Assessment: An Overview






This is a video post (click above to see the accompanying videos for this post) and quick overview of the VB -MAPP assessment tool. 
VB- MAPP stands for Verbal Behavior Milestones Assessment and Placement Program, and it was developed by Dr Sundberg, one of the creators of the ABLLS assessment tool (the newer version, the ABLLS-R, was authored by Dr. Partington).

I already have a post about the ABLLS- R, which is mainly what I have used over the years. I am newer to the VB MAPP but I already really like it. Most ABA professionals use the VB -MAPP or ABLLS-R assessments, so whether you are a parent or a professional it’s good to have some knowledge of these assessment tools.


I do have some reasons why I like the VB -MAPP over the ABLLS-R. Mainly the VB- MAPP can be MUCH quicker to administer (how does 1 day sound?) than the ABLLS-R. 
 I also love the Barriers Assessment in the VB-MAPP, and having a focus on developmental milestones because then I can say to a parent “Your child cannot perform XYZ skill, which a typical child would be able to do by age 18 months”. Being able to talk about age equivalents can be very helpful for parents who may know their child is delayed, but don’t really have a sense of the depth or severity of delay.

The VB -MAPP can be purchased as just the protocol or you can purchase the protocol and guide together. I would really recommend buying both, because the guide is very helpful. This isn’t one of those assessments that you want to purchase and then just implement. Reading the guide will help you assess more accurately, as well as be able to discuss the results clearly and thoroughly with the family. Assessment methods can include observation (timed or not) or direct testing. The VB- MAPP will tell you which method to use depending on what skill you are assessing


The focus of the VB MAPP assessment is on Verbal Behavior  and developmental milestones of typically developing children. The assessment also covers academics, social/play, motor skills, etc.
In my opinion, this assessment tool is more for professionals than parents. You really need a solid understanding of Verbal Behavior, verbal operants, and like any assessment tool, you need an understanding of gaining instructional control  and pairing with a child.

Pairing and instructional control are hugely important when assessing anyone. As the assessor, you often are walking into a situation where you don’t know the individual, and have to quickly establish a good rapport so you can begin your assessment. The parents can help greatly with this process, as they can give you information about what the child finds reinforcing, what kind of games/toys they like, what time of day are they best able to attend, etc. This is also why it can be so helpful to conduct a record review, observation, and parent interview before doing the actual assessment. I often find that the assessment is an under-representation of what the individual can do, either due to problem behaviors during assessment or the individual being uncomfortable interacting with strangers.

 You should be reinforcing and fun during an assessment, but be careful with prompting. Depending on the skill you are assessing using the VB- MAPP prompting may be allowed, or it might not. The goal of assessment isn’t to teach, it’s to determine the level of functioning. So you shouldn’t be using excessive prompting. Remember: If you can’t praise the performance you can always reinforce effort (“You are trying so hard!”)

The VB -MAPP covers 170 milestones, and has 3 main sections: Milestones assessment, Barrier assessment, and Transitions assessment. The best plan is to complete all 3, in order to gain a comprehensive view of current functioning level. 

- The Milestones assessment has 3 developmental levels: from 0-18 mo (Level 1), 18-30 mo, (Level 2), 30-48 mo (Level 3). Level 1 is typically a very young child, nonverbal, who has never received treatment/intensive therapy before. The parent interview and observation will give you a good idea of which level to start assessing on. It will become clear pretty quickly if you need to move down a level, as the child will be unable or unwilling to answer your questions, or participate in activities. You could also start to see many problem behaviors (escape behaviors) if you are starting at a level too difficult for the child. Level 2 would be an intermediate level, and it adds more domains to cover such as Intraverbals (link). Obviously, a non verbal child doesn’t need to be assessed on Intraverbals, so you can see how the difficulty is increasing as the levels go up.  Level 3, which would be an advanced learner or possibly an older, higher functioning individual, covers the most skill domains and includes more complicated skills such as academic skills and classroom routines. This applies to all the levels but particularly for level 3: you will likely need to observe the child in the classroom or in a social setting to assess certain parts of the VB -MAPP. If it isn’t possible to observe the child at school (they don’t always let ABA professionals inside) then indicate a score of “0” since you weren’t able to assess the skill, or, you can try to gain the information you need from teacher interview.


-The Barriers assessment is probably my favorite feature of the VB- MAPP. This tool answers the question: What issues are present that could impede learning and/or progress? This is so helpful as the person responsible for creating the treatment plan, and I use this along with parent concerns to create the initial behavior plan. During the assessment, you could see all kinds of lovely problem behaviors and this information would go directly onto the Barriers assessment.


-The Transitions assessment can help identify if the child is school ready, and what the ideal school setting would be for that child. Can they attend within a group? How sociable are they with peers? Do they exhibit challenging problem behaviors? All of this will help determine what kind of classroom placement a child would need, and I highly recommend sharing this information with the family and with the teachers. For school age clients, this information can be used to help develop the IEP.


*For more information: 
VB MAPP website (Dr. Sundberg’s website) http://www.avbpress.com/vbmapp-set.html
Friday, July 5, 2013

Newly Diagnosed….Now what??







For years I have received emails or phone calls from parents wanting to begin ABA services for their child, and full of more questions than answers. Even for people who know what ABA can do, they usually don’t know how to get started. Most parents who contact me are confused and frustrated, and still dealing with the emotional blow of the Autism diagnosis. Some parents have told me they wish the Autism diagnosis came with a fact sheet, or road map of what to do next. That would be pretty difficult to do. Autism impacts each child differently, and an Autism diagnosis is somewhat like a gemstone with many different facets and depths to it. There is no “Autism prescription”. The treatment package will vary from one child to the next.  

Now that I have a blog, I am so-o-o-o happy to share this information with a wider audience. Information is only helpful when it is shared, so give the information in this post to anyone you may know who needs ABA therapy but maybe they’ve never heard of it, or don’t know where to start.

I'm going to generalize a lot in this post because ABA services vary so greatly based on location. Here is a generic guide of how to begin ABA therapy:

- The first thing you need to do is locate the ABA providers in your area. There may be agencies that send therapists to your home, private Autism schools, or centers where you drop your child off for therapy. If your child is under 3 there should be free Early Intervention services available to you, although early intervention doesn’t always offer ABA.  Contact the ABA providers to determine who has availability. It isn’t uncommon to contact an agency and be told there is a long waiting list. This can actually be a positive, because it means the company doesn't have adequate staff to cover cases. Instead of cramming a heavy caseload on their staff, a company will start a waiting list and take the time to hire quality staff. If there are no ABA providers in your area, I suggest starting your own in-home ABA program. Parents will often ask me where to go to find ABA therapists. There is no easy answer to that question. You may need to put up flyers on college campuses, ask other parents for recommendations, or hire non-trained individuals and pay a Consultant to train them. The average hourly rate for an independent ABA therapist is $12/hour.

-Sometimes if you get a referral or contact individuals through your insurance, the roles of ABA providers are not properly explained. Here is what I mean by that: usually an ABA Therapist and a BCBA do not perform the same tasks. Often parents contact me after getting a referral and they inquire about starting ABA therapy. I then have to explain that I provide case supervision and consultation; not direct 1:1 therapy. Which can be highly disappointing to families. Are there BCBA's who work 1:1 with clients? Sure there are. But typically, if you are new to ABA what you want are ABA direct staff first, and then once you have a team in place you want a BCBA to supervise everything and create the treatment plan.

- The next step will be securing funding. The provider will inform you if they accept insurance, Medicaid, have a sliding fee scale, offer scholarships, or they may even tell you about grants available in your local area. If there are Regional Centers in your area, they are the ones who typically pay for ABA so you should contact them first. If the provider does accept insurance, you may have to secure the funding before services can even start. This is because sometimes insurance companies take months and months to approve services, so the provider may need to determine up front that the insurance company will actually pay the claim. If you live in an area without ABA mandated services, you will need to locate funding sources yourself, or possibly pay out of pocket for therapy.

- Now that you have a provider and funding, you are ready to begin ABA therapy. Whether the provider comes to your home, or you take your child to the center/school, you (by “you” I mean all caregivers) will need to receive ABA training. For many agencies and companies this is mandatory—families cannot begin therapy until they have completed initial family training. If you are working with an independent contractor (they work for themselves, not an agency) then I highly recommend you request initial training from that person. If the independent contractor is not qualified to conduct trainings, you may need to receive training separately. It will be very important that the family learn how to apply the fundamental techniques of ABA. In order to see the most benefit from the ABA therapy, the family must reinforce what the therapists are teaching. This will be very hard to do without ongoing caregiver training.

- Lastly, what is most important about beginning ABA therapy is understanding that ABA is a lifestyle change and a commitment. It isn’t something you “kinda sorta” do. You will likely have a team of professionals coming in and out of your home several times each week, and it can be annoying, frustrating, invasive to your privacy, and overwhelming. Its also important to remember: Autism doesn’t take a day off, so ABA shouldn’t take a day off. ABA therapy shouldn’t stop because the family moves to a new home, the ABA therapist is sick, the grandparents are visiting for Thanksgiving, or because school starts. When the ABA providers are not working 1:1 with your child, then guess who is now the acting ABA therapist? That’s right, you are.

ABA is a commitment to a lifestyle change, and I can quite honestly say that parents who don’t understand or agree with that commitment do not see the progress they are expecting to see from ABA therapy.


**Quick Tip: For those of you still on the fence about if ABA therapy is necessary for your child, I suggest reading my “What is ABA?” post. 

Resource: Autism Speaks 100 Day Kit